Housebound pensioner Hazel Williams, who has been told she will face a five-year delay for a NHS shoulder replacement in a Belfast hospital, is planning to head to Lithuania for surgery. Picture by Ann McManus.

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Under an EU scheme, patients can pay for treatment in another EU state and be reimbursed by the NHS

THE Northern Ireland health service has spent almost £650,000 reimbursing almost 200 patients who have travelled across Europe to pay for their own operations due to appalling NHS waiting lists.

The Irish News has learned that an EU scheme introduced four years ago which allows people to seek care outside the north has led to health chiefs approving the payments.

Orthopaedic procedures account for the majority of the surgeries performed but patients with brain-related illnesses and kidney conditions have also applied for reimbursements after travelling to countries including Slovakia, Cyprus, Lithuania, Hungary, Spain, Germany and the Czech Republic.

Procedures have also been carried out in private clinics in the Republic of Ireland, as well as France, Poland and Germany.

Waiting lists for routine surgery at a record-breaking high

Waiting lists for routine surgery are now at a record-breaking high across the north’s five health trusts - with some patients facing five-year delays for hip and knee replacements.

The Health and Social Care Board (HSCB), which is responsible for 'commissioning' or buying healthcare services in Northern Ireland, confirmed the payments but was unable to comment on the future of the programme post-Brexit.

Known as the 'EU Directive 2011/24 on cross border healthcare', a detailed application form must be filled in by patients which is then forwarded to the Board which decides on their eligibility.

Surgery across a wide range of specialties can be carried out in either state or private clinics, with the patient paying in advance for all costs, including travel, accommodation and the surgery itself as well as post-operative care.

The HSCB only covers the cost of treatment and will not reimburse travel.

However, the combined cost of flights, hotels and operations in parts of Eastern Europe are often significantly less than the cost of one operation in a private Northern Ireland clinic.

Package deals of £6,000 are being advertised online for hip replacements in a hospital in Vilnius in Lithuania – including travel, surgery, post-op care and optional travel insurance – compared with £11,000 for the procedure alone in Belfast.

While the EU directive was originally conceived to improve treatment options for European citizens, it is now being used as a last resort by many patients enduring lengthy delays for procedures defined as non-emergency – but that have a devastating impact on their health.

Earlier this year private hospitals in Dublin were advertising in Belfast newspapers about the scheme.

Doctor's concern about infection control standards

However, one doctor has warned that patients travelling south should be wary about charges, as the health service will only cover what the procedure costs in the north.

Dr Tom Black of the British Medical Association also said he had concerns about infection control standards in parts of Eastern Europe.

“While I would have no issue with governance arrangements in the Republic - as many northern doctors including myself trained there - in relation to infection control and prevention, standards can be different in other parts of Europe,” he said.

A HSCB spokeswoman revealed that it has green-lighted a total of 278 applications for treatment across Europe and already reimbursed 184 patients over the past four years.

On the impact of Brexit on the scheme, she said: "The Department of Health is working closely with counterparts in other Northern Ireland departments, England, Scotland, Wales and the Republic of Ireland as we prepare for the implications of leaving the EU and determine the decisions and actions that need to be taken."

One leading GP - who has a housebound patient applying for treatment in Lithuania - said it highlighted the serious failings of the north's health service.

"In my 20-year history as a GP these are the longest waiting lists I have seen. This would not be tolerated in England yet it is tolerated here - where is the equity?" said Dr Michael McKenna, who has a practice in west Belfast.

"Previously, patients went abroad for weight-lose surgery or cosmetic surgery but it's now come to the point where people are footing the bill for NHS operations you should be able to get at home.

"I think it's pretty shameful that people have to leave the country when the majority have paid taxes all their lives. We are letting patients down."

Janice Smyth, director of the Royal College of Nursing, also raised concerns about 'vulnerable people' being forced to access care abroad and called on the HSCB to source services in Europe.

"I don't think it's acceptable, when we have a local commissioning Board, that individual members of the public are having to source healthcare elsewhere," she said.

"If we can't get the waiting lists down, the Board itself should be exploring and commissioning services across Europe."

Case Study: Hazel Williams booked 'cut-price' surgery abroad when a Belfast surgeon told her she could have to wait a further two years for an operation

Pensioner Hazel Williams says she is going to Lithuania for shoulder operation due to appalling five-year waiting list delays for surgery in Northern Ireland. Picture by Ann McManus.

A PENSIONER on a five-year waiting list for a shoulder replacement is heading to Lithuania for 'cut-price' surgery in the hope of getting reimbursed by the NHS.

Hazel Williams (65), who lives in a fold in north Belfast but previously worked in Hong Kong and Africa as an international business advisor, broke her shoulder while kayaking in Thailand six years ago.

The keen sportswoman, who is morphine dependent and housebound due to the severity of her injuries, said she has 'maximised the limit' on three credit cards to pay the £7,000 fee for orthopaedic surgery in Eastern Europe - including flights and accommodation - compared with £11,000 in a private clinic in the north.

Mrs Williams, a widow whose background is in art and is originally from England, was informed by a Belfast surgeon in June that it could be another two years before a date becomes available for a NHS operation due to the massive patient backlog.

She has spent the past three years on a waiting list for a first appointment with a hospital consultant following a referral from her GP.

While reluctant to travel abroad, she said she cannot endure any further delays due to her poor quality of life.

"For the past week, I haven't been able to walk. My shoulder has become so damaged waiting for surgery that further complications have developed. A few months ago I ended up with vascular blockages to my brain that almost killed me. I developed black-outs and lost some of my vision," she said.

"Basically I have been grounded. I have always been very active and independent. I had my first x-ray in October 2014 which told me I needed surgery - I thought I would have had my operation long before now.

"Over the past year my health has really deteriorated and I am on heavy pain relief. I haven't been out in two weeks.

"When the consultant told me it could be another two years I decided that I'd had enough and started looking on the internet for private clinics abroad that carried out shoulder replacements.

"Depending on whether I choose titanium or a plastic mould, I will pay between £6,000 to £7,5000 for a five-day stay in a Lithuania hospital.

"My GP had told me I could be reimbursed through the NHS, something I didn't realise I could do, and I've asked him to fill out the form as it's very detailed."

Analysis: Urgent solutions required for a shameful solution

SPIRALLING surgical waiting lists in England were only pipped in the BBC headlines last week by US President Donald Trump threatening nuclear war against North Korea.

It emerged that one million patients are now waiting in excess of 18 weeks for 'routine' operations in England.

But in today's Irish News, the story of a housebound pensioner who faces a five-year wait for orthopaedic surgery is one that is replicated thousands of times across Northern Ireland.

While the issue of waiting lists may have slipped off the news radar this summer against a backdrop of bonfires and political dysfunction, the fact that a frail, morphine-dependent woman is maxing out three credit cards to pay for a shoulder replacement in Lithuania is a shocking indictment of our health service.

Hazel Williams, a previously healthy, independent woman who travelled the world through her work, is among a growing number of vulnerable patients using an EU scheme to travel abroad for routine surgery that should be available on the NHS.

To date, almost 300 patients in the north have been approved for reimbursement by the north's main health body, the Health and Social Care Board, with expenditure set to top £1m once the payments have been settled.

It is understandable that people with an appalling quality of life as in the case of Mrs Williams would resort to getting themselves into debt to get treatment, in the hope of then clawing money back from the NHS.

But the reality is, as one GP spells out today, the north's waiting list scenario would simply not be tolerated in England - where there is an outcry when patients are waiting longer than four months for operations.

With a mothballed Stormont and a £60 million bail-out for the north's health service somewhere in the ether, surely the Health and Social Care Board along with senior civil servants at the department must recognise the need to urgently find solutions to a shameful situation that has made us the worst performing service in the entire NHS.